Fibromyalgia
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What is Fibromyalgia Syndrome?

Fibromyalgia; It is a chronic musculoskeletal disease characterized by widespread pain and sensitive points in certain parts of the body. It is a chronic disease that does not cause limitation of movement and deformity in the joints but disrupts the quality of life of the person.

What are the conditions that cause Fibromyalgia?

Although the cause of the disease is not known, stress, anxiety, depression, perfectionist personality, neurohormonal disorders, immune system disorders, muscle problems, flu-like viral infections, noise, physical injuries, physical and psychological trauma (car accident, childhood sexual abuse, divorce, It is thought that many conditions such as the death of a person), heavy work pace, damp environment, sleep disorders, and long-term computer use cause fibromyalgia in those with a genetic predisposition.

What is the prevalence of Fibromyalgia and who is it seen?

It affects about 2% of the society. Although it can be seen in all ages and both genders, it is most common in women between the ages of 25-55 and more in women than men. This disease is also seen in children and the elderly.

What are the symptoms of Fibromyalgia?

The signs and symptoms that make up the clinical picture in fibromyalgia syndrome are diverse. The main signs and symptoms are chronic widespread pain, stiffness, fatigue, tender and painful points, and sleep disturbance.

What are the physical examination findings?

Painful points: It is pain in 11 of 18 special points in various parts of the body by applying a pressure of 4 kg with the finger defined by the American Rheumatology Association (ACR).
Dermo graphism: It is a form of urticaria (hives) that occurs following the scratching or rubbing of the skin with a hard object or where clothes and underwear squeeze the body.
Cutis anserine: Skin condition characterized by the erect hair on it due to cold or fear; goose skin.
Cutis marmaratus: Red-purple lines on the skin caused by circulatory disturbance resulting from infection or sudden temperature changes.

How is Fibromyalgia diagnosed?

Laboratory tests and radiological examinations in fibromyalgia are not performed for diagnosis but to exclude diseases that may be confused with other fibromyalgia. Laboratory tests give normal results in fibromyalgia. If there are no inflammatory rheumatic diseases or signs of neck and lumbar hernia, radiological examination is not required. Fibromyalgia is diagnosed by anamnesis and clinical examination. Fibromyalgia is diagnosed with widespread pain in the right and left half of the body, lower and upper waist for more than 3 months, as well as pain in the spinal axis and detection of 11 painful points on examination.

What are the conditions confused with Fibromyalgia?

Inflammatory rheumatic diseases, hypothyroidism, neuropathic pains, chronic fatigue syndrome, myofascial pain syndrome and some neurological diseases and cholesterol lowering drugs (Statins)

What are the goals in Fibromyalgia treatment?

Today, there is no treatment that provides full recovery of fibromyalgia. Treatment is aimed at reducing complaints, preserving and improving quality of life and functions.

Fibromyalgia Treatment

What are the treatment approaches in Fibromyalgia?

Treatment in this disease can be done with 4 main approaches. Medication. physical therapy, psychosocial approach and complementary therapies

Psychosocial approach

In treatment, as in any disease, it is very important to inform and educate the patient about the disease. The aim of the training is to improve the patient’s self-management and self-efficacy, to gain the ability to cope with complaints, and to positively change negative perceptions such as frustration and helplessness. In addition, the patient’s compliance with the treatment should be increased with education. The patient should be told that his illness is “real”, but not a deforming or disabling illness.

Treatment begins with the patient getting rid of mechanical stresses. Then, it is necessary to try to reduce harmful habits such as alcohol and smoking because they both increase pain and weaken the muscles. Excessive caffeine intake disrupts sleep quality and increases the patient’s complaints.

In treatment, the patient should be taught some behavioral changes. Patients should be told to stay away from stress and excessive excitement and try to reduce their tension. The perfectionist personality of the patient and his meticulousness in daily life activities should be shown to him and he should be told that he should take a break while doing physical activity, housework and hobbies.

The patient should be motivated to work and be active. However, the patient’s job should not be sitting or standing for a long time, and the patient’s workplace and working conditions should be regulated.

Medication

In the treatment of fibromyalgia, pain medications, antidepressants, anti-epileptics, muscle relaxants and sleep regulating drugs are used according to the patient’s condition and the patient.

Physiotherapy

Physical therapy sessions and exercise programs, which occupy the most important place in treatment, are applied.

In physical therapy, currents to reduce pain such as hot application, TENS or interference, ultrasound, laser, hil therapy, cupping therapy, massage, taping, dry needling, trigger point injections, mobilization and manipulation applications can be performed.

With hydrotherapy, a decrease in the pain threshold and the number of painful points and an increase in quality of life are provided.

Exercises

The main objectives of exercise are to reduce stress, maintain and increase muscle strength and endurance, and provide proper posture. It is known that patients with fibromyalgia have a decrease in muscle strength and muscle condition. Poor condition also increases the risk of muscles being affected by microtraumas, causing pain and fatigue. In general, cardiovascular (aerobic), strengthening, stretching, relaxation and exercises in water have been found to be beneficial in fibromyalgia. Studies have found that cardiovascular (aerobic) and strengthening exercises improve physical functions, quality of life and pain. Since the pain and fatigue of these patients increase when they start exercising, light activities such as walking, swimming, cycling can be done first. The exercise program can be gradually increased as the condition and muscle strength increase over time. The type and intensity of the exercise should be adjusted according to the patient. These exercises should be done 3-4 times a week for 20-30 minutes.

Posture exercises are important for these patients to evaluate posture and correct poor posture. Patients should be advised to sleep in an orthopedic bed and use orthopedic pillows.

Complementary treatments

Nutrition, Ozone therapy, acupuncture, hypnosis, clinical Pilates and meditation techniques (TAI chi, Yoga, Qi gong) can be applied as part of the treatment in fibromyalgia patients, in accordance with the clinical condition and conditions of the patient.

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